HIV-1 mother-to-child transmission, post-test counselling, and antiretroviral prophylaxis in Northern Viet Nam: A prospective observational study

Abstract

Background: Pregnant women fear being identified as HIV-1-infected and this has hampered prevention programmes and the calculation of transmission rates in Viet Nam. We introduced post-test counselling, antiretroviral prophylaxis, and formula feeding, and determined the vertical transmission rate in parts of Northern Viet Nam. Methods: HIV infection was identified in 234 pregnant women; 182 (77.8%) accepted follow-up of their children. Counselling was given on 3–7 occasions for altogether approximately 6 h on antiretroviral prophylaxis and formula feeding to avoid transmission, and on the importance of surveillance of the child. All children were formula-fed. A polymerase chain reaction (PCR) was used for the diagnosis of HIV-1 in the children. One hundred and thirty-five of the 182 mothers allowed ≥3 blood samples to be taken from birth to ≥1 y of age, 32/182 provided a birth sample only, and 15/182 provided a sample later only. Nevirapine was given at delivery to 93/135 (69%) women, and to 128/135 (95%) children. Additionally, combination therapy was given to 15/135 (11%) who entered the study before delivery, and azidothymidine to their children for 1 week. Results: Nine of 135 (6.7%) children became infected and 2/15 of the others, giving altogether 11/150 infected (7.3%). Intrauterine transmission was identified in 7/167 (4.2%) children by a positive PCR test at birth. PCR was negative at birth but positive at 1 month in 2/135 (1.5%), pointing to delivery-associated transmission. Thus, intrauterine transmission accounted for 78% (7/9). None of the uninfected children died, but 3/11 (p =0.004) of the HIV-1-infected died (in AIDS). Conclusion: Post-test confidential counselling, formula feeding, and antiretroviral prophylaxis resulted in low rates of delivery-associated and late HIV-1 transmissions.

Keywords::

• Vertical transmission
• infants
• HIV in pregnancy
• prevention
• epidemiology
• South East Asia

Acknowledgements

We would like to thank David Dunn for providing details from his publication [25] for the statistical comparison of the transmission rate in utero and during delivery and for suggestions on how to perform the statistical analysis. Antiretroviral prophylaxis was provided by the Vietnamese National programme for the prevention of mother-to-child transmission of HIV. The project “Mother-to-child transmission of HIV” was sponsored by SIDA (Swedish International Development Cooperation Agency) through the Ministry of Science and Technology, Viet Nam, to Dr. Pham Le Tuan 2004–2005 and Dr. Nguyen Tran Hien 2006–2007, covering extra costs in Viet Nam. Dr. Tran Thi Thanh Ha was given a research grant from the Karolinska Institutet Research Training Program (KIRT) for post-graduate training and a short-term grant from a Marie Curie Early Training Program on HIV and Tuberculosis. She also received a grant from The Swedish Nutrition Foundation. Rozina Caridha also received a short-term grant from a Marie Curie Early Training Program on HIV and Tuberculosis. Simani Gaseitsiwe received a 3-y Marie Curie Early Training Program on HIV and Tuberculosis grant for his PhD studies. Anneka Ehrnst received a grant from SIDA, on mother- to-child transmission of HIV-1, covering costs in Sweden not covered by other grants, as well as from the Karolinska Institutet. None of the sponsors had any influence on the collection, analysis, or interpretation of the study data, nor in the writing and submission. All work by the investigators was carried out independent from the funding agencies.

Reporting of biomedical research of an observational study: The STROBE Statement instructions were followed, which consist of a checklist of items that should be included in reports of observational studies, as well as the TREND checklist for non-randomized evaluations of behavioural and public health interventions. The study was registered with ClinicalTrials.gov ID: NCT00669604 at https://register.clinicaltrials.gov./prs/app/action/FilterOrSelectProtocol/selectaction/view/ts/6/uid/U0000MHB.

Preliminary presentations and associated reports: Preliminary results were presented at the conference “Maternal chronic viral infections transmitted to the infant: from mechanisms to prevention and care” in Paris, December 13–15, 2007, and the abstract has been published [34]. Similarly, this work was presented in preliminary form in the PhD thesis (Karolinska Institutet, 2008 [35]) of Tran T. T. Ha entitled “HIV-1 genotype and vertical transmission in Northern Viet Nam”.

Competing interests: Each author declares that they have no competing interests.